Psychiatric Holds in California: Educational Guide
A comprehensive interactive guide to understanding the Lanterman-Petris-Short (LPS) Act and all types of psychiatric holds in California, based on the provided chart and official sources. Click on sections to expand details and test your knowledge with the 10-question quiz below.
Sources: Disability Rights California - Understanding the LPS Act (2023); Orange County Health Care Agency - 5150/5585 Supplementary Material (revised 01.26.2024); California Welfare and Institutions Code. For legal advice, consult a professional.
Introduction to the LPS Act
The Lanterman-Petris-Short (LPS) Act, part of the California Welfare and Institutions Code (WIC), regulates involuntary civil commitment for mental health treatment. Enacted in 1967, it aims to end inappropriate, indefinite, and involuntary commitments; provide prompt evaluation and treatment; protect public safety; safeguard individual rights; and encourage community-based services over institutionalization. Key principles include treatment in the least restrictive environment, protection of civil rights, and consideration of alternatives to hospitalization.
Types of Psychiatric Holds
Below is a detailed overview of every hold type from the LPS Holds Chart, including criteria, duration, initiating parties, process, rights, and extensions. Each hold builds on the previous ones in escalating levels of intervention.
Duration: Up to 72 hours (may be released earlier).
Criteria: Due to a mental health disorder, the person is a danger to self (DTS), danger to others (DTO), or gravely disabled (GD - unable to provide for food, clothing, or shelter; not solely due to homelessness or poverty).
Initiating Parties: Peace officers, county-designated mental health professionals, or facility staff.
Process/Steps: Individual is detained and transported to a designated facility for assessment. Evaluation must consider full context (medical, psychological, social, etc.). No probable cause hearing required unless extended. Outcomes: release, voluntary admission, or escalation to 14-day hold.
Patient Rights: Notification of hold reasons, right to phone call, advocate access, habeas corpus petition, refuse non-emergency medications (with informed consent), safeguard personal property.
Extensions/Related Procedures: Can lead to 5250 if criteria persist and voluntary treatment is refused. For minors (5585), similar but with additional safeguards.
Duration: Up to 14 days.
Criteria: Continues to meet 5150 criteria (DTS, DTO, or GD) and unwilling/unable to accept voluntary treatment.
Initiating Parties: Treating physician or facility staff, signed prior to 5150 expiration.
Process/Steps: Written notice provided. Certification Review Hearing (probable cause) within 4 days (unless waived or habeas requested). Hearing officer determines if hold continues. Burden on facility to prove criteria.
Patient Rights: Attorney/advocate, present evidence, question witnesses, medication disclosure if recent, one habeas corpus request, Riese hearing for medication capacity.
Extensions/Related Procedures: Can extend to another 14-day (5260) for DTS/DTO, 30-day (5270) for GD, or 180-day (5300) for DTO. May initiate conservatorship petition.
Duration: Up to additional 14 days.
Criteria: Still meets criteria for DTS or DTO after initial 14-day hold.
Initiating Parties: Treating facility staff.
Process/Steps: Recertification without mandatory probable cause hearing. Continue intensive treatment.
Patient Rights: Habeas corpus at any time, new Riese hearing for medications, advocate access.
Extensions/Related Procedures: May lead to 180-day post-certification for DTO or conservatorship for GD.
Duration: Up to 30 days (county-optional).
Criteria: Still gravely disabled after 14-day hold.
Initiating Parties: Treating facility.
Process/Steps: Probable cause hearing within 4 days. Focus on intensive treatment for GD.
Patient Rights: Similar to 5250: advocate, habeas corpus, Riese hearing.
Extensions/Related Procedures: Often overlaps with temporary conservatorship petition if longer-term needed.
Duration: Up to 180 days, renewable.
Criteria: DTO with recent violent act or threat during prior hold, due to mental disorder.
Initiating Parties: District Attorney petitions court before 5250/5260 expiration.
Process/Steps: Arraignment hearing in court. Jury trial possible if requested. Focus on post-certification intensive treatment.
Patient Rights: Court-appointed counsel, evidence presentation, Riese hearing for medications.
Extensions/Related Procedures: Renewable if criteria persist; alternatives like conservatorship considered.
Duration: 30 days to 6 months.
Criteria: Gravely disabled, no suitable alternatives to conservatorship.
Initiating Parties: Treating physician applies to Public Guardian's office.
Process/Steps: Judge reviews application. Temporary conservator appointed for interim management while investigating permanent need.
Patient Rights: Habeas corpus, "Meredith" capacity hearing for medications, notice of rights.
Extensions/Related Procedures: Leads to full conservatorship investigation and hearing.
Duration: 1 year, renewable annually.
Criteria: Gravely disabled due to mental disorder, unwilling/incapable of voluntary treatment.
Initiating Parties: County Public Guardian or designee petitions court after investigation.
Process/Steps: Court hearing with evidence; possible jury trial. Conservator (family or public) appointed to make decisions on residence, treatment, etc. Annual review required.
Patient Rights: Counsel, present evidence, least restrictive placement, retain voting/driver's license unless restricted, periodic review, termination if no longer needed.
Extensions/Related Procedures: Renewable with court hearing; can be terminated early if criteria no longer met.
Patient Rights Under LPS
All individuals under LPS holds have protected rights to ensure due process and humane treatment:
- Non-Deniable Rights: Dignity and privacy, humane care, freedom from harm/abuse, prompt medical care, religious freedom, education participation, social interaction, physical exercise, civil service rights.
- Deniable for Good Cause (with Documentation): Own clothing, personal possessions, spending money, storage space, visitors, phone/mail access.
- Additional Protections: Access to patients’ rights advocate, habeas corpus petitions, Riese hearings for medication refusal/capacity, informed consent for treatments, least restrictive environment.
Riese Hearings: Determine capacity to refuse antipsychotics; can be requested anytime, with new hearing per hold extension.
Knowledge Quiz
Test your understanding with this 10-question quiz covering all LPS hold types. Explanations will be provided after submission.